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显微输精管附睾吻合术后复通的影响因素分析

Multifactor analysis of postoperative patency of microsurgical vasoepididymostomy

摘要:

目的 分析影响显微输精管附睾吻合术后复通的相关因素.方法 回顾性分析我院2014年9月至2016年6月行显微输精管附睾吻合术的94例附睾梗阻性无精子症患者的临床资料.年龄(30.7±4.8)岁,体重指数(25.1 ±3.0)kg/m2.93例已婚,1例未婚.94例查体及阴囊超声检查提示睾丸形态正常、附睾饱满、输精管正常;镜下精液检查≥2次提示无精子.所有患者均行显微输精管附睾吻合术,手术均由同一位熟练掌握该技术的高年资主任医师完成.患者术后1、3、5~6个月规律复查精液常规,此后每3~6个月复查1次.门诊和/或电话随访了解术后复通情况,精液常规≥2次发现精子为复通成功.采用x2检验对影响显微输精管附睾吻合术后复通率的因素进行单因素分析,利用logistic回归进行多因素分析.结果本组94例均顺利完成手术,其中82例获得随访,12例失访,随访率87.2%(82/94).随访时间12 ~ 33个月,中位时间19个月.82例随访患者中59例复通,总复通率为72.0% (59/82),自然受孕率为32.8% (19/58).≤28岁和>28岁患者术后复通率分别为89.3%(25/28)和63.0%(34/54,P=0.012);体重指数<26.0 kg/m2和≥26.0 kg/m2患者的术后复通率分别为80.4%(41/51)和58.1%(18/31,P=0.029),差异均有统计学意义.双侧吻合和单侧吻合患者术后复通率分别为72.1% (44/61)和71.4%(15/21,P=0.951).根据手术情况,至少一侧最终吻合于附睾头部患者和最终吻合于附睾体、近尾部患者术后复通率分别为75.0%(15/20)和71.0%(44/62,P=0.727).术中调整吻合部位和未调整吻合部位患者术后复通率分别为77.8%(7/9)和71.2%(52/73,P=0.680).术中附睾液镜检仅见少量精子患者和可见较多精子患者术后复通率分别为50.0%(4/8)和74.3%(55/74,P=0.146).镜检偶见或未见活动精子患者和镜检可见较多活动精子患者术后复通率分别为73.8% (31/42)和70.0%(28/40,P=0.701).多因素logistic回归分析结果显示年龄与术后复通显著相关(OR =4.705,95%CI 1.181~18.742,P=0.028).结论年龄≤28岁、体重指数< 26.0 kg/m2的患者显微输精管附睾吻合术后复通率高.年龄是术后复通的独立影响因素.手术侧别、吻合部位调整、最终吻合部位以及术中镜检附睾液精子的数量和活力与术后复通无明显相关性.

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abstracts:

Objective To analyze the factors which may affect postoperative patency of microsurgical vasoepididymostomy (VE).Methods Ninety-four patients underwent VEs from September 2014 to June 2016 in the Department of Urology,Peking University Third Hospital,with average age of (30.7 ± 4.8) years,and body mass index (BMI) of (25.1 ± 3.0) kg/m2.Semen analyses were performed 1 month,3 months and 5 to 6 months after the operation.The following semen analyses were performed every 3-6 months thereafter.Patency was defined by finding sperms in twice or more analyses during the followup until August 2017.Patients were followed up by face-to-face or telephone interview.Seven factors (age,BMI,bilateral or unilateral anastomosis,anastomosis sites,the adjustment of anastomosis sites,motility and quantity of sperms found in epididymal fluid) were analyzed by Chi-square analysis and multifactor logistic regression analysis.Results Eighty-two patients were followed up (87.2%,82/94) while 12 patients were lost of follow-up.The mean follow-up time was 19 months.Sperms were found in the ejaculate in 59 patients postoperatively.The overall patency rate was 72.0% (59/82),and natural paternity rate was 32.8% (19/58).Patients ≤28 years old and those >28 years old had patency rates of 89.3% (25/28) and 63.0% (34/54,P =0.012),respectively.Patients with BMI <26.0 kg/m2 and BMI≥26.0 kg/m2 had patency rates of 80.4% (41/51) and 58.1% (18/31,P =0.029),respectively.Patency rate of bilateral surgery was 72.1% (44/61) and of unilateral surgery was 71.4% (44/62,P =0.727).Patency rate of caput anastomosis achieved 75.0% (15/20) and of corpus/caudal anastomosis was 71.0% (44/62,P =0.727).Patency rates of patients with and without adjustment of anastomosis sites were 77.8% (7/9) and 71.2% (52/73,P =0.680),respectively.Patency rates of a lot,a few,motile and seldom-motile sperms in epididymal fluid were 74.3% (55/74) vs.50.0% (4/8,P =0.146) and 70.0% (28/40) vs.73.8% (31/42,P =0.701),respectively.Multifactor logistic regression analysis showed that age was well associated with patency rate (OR=4.705,95%CI 1.181-18.742,P=0.028).Conclusions Age ≤28 years is an independent factor leading to higher patency rates.Patients with lower BMIs and younger could have higher patency rates.Factors of anastomosis sides,anastomosis sites,the adjustment of anastomosis sites,motility and quantity of sperms found in epididymal fluid showed no statistical difference in patency rates.

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作者: 王首洋 [1] 洪锴 [1] 田雨 [1] 郝一昌 [1] 赵连明 [1] 毛加明 [2] 刘德风 [2] 林浩成 [1] 唐文豪 [1] 姜辉 [1] 马潞林 [1] 乔杰 [2]
期刊: 《中华泌尿外科杂志》2018年39卷6期 441-445页 ISTICPKUCSCD
栏目名称: 临床研究
DOI: 10.3760/cma.j.issn.1000-6702.2018.06.010
发布时间: 2018-07-23
基金项目:
国家重点研发计划 北京自然科学基金(7182177)National Key R&D Plan of China Beijing Natural Science Foundation of China
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